Provider Demographics
NPI:1912483397
Name:DEERE, AMBER DAWN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:DEERE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:HALLOCK
Mailing Address - State:MN
Mailing Address - Zip Code:56728-4215
Mailing Address - Country:US
Mailing Address - Phone:218-843-2165
Mailing Address - Fax:
Practice Address - Street 1:603 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-2914
Practice Address - Country:US
Practice Address - Phone:218-281-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5989363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health